Sexual Health in Practice (SHIP), an educational programme tailored to general practice, increased GPs’ rates of HIV testing.

SHIP training was commissioned intermittently in 52 general practices in the London Borough of Haringey from 2008 to 2010. SHIP is a peer-developed and peer-led educational intervention tailored to general practice to improve sexual healthcare.

Over the eight years of the study there were two fallow periods without training of 12 and 23 months respectively. Anonymous data were collected monthly on GPs and nurses from practices which were exposed to SHIP training and the numbers of HIV tests performed by each practice. SHIP attendance was recorded on a register at training events which collected details including the participant’s name, role and practice. The number of HIV tests from each practice was obtained from local laboratories.

By the end of the study period, an average of two GPs per practice had been trained and 46 of the 52 practices had at least one trained GP. Average monthly HIV tests per practice increased from one to six over the study period.

On average, for each additional GP completing SHIP training, monthly HIV test rates increased by 16%. The testing rate ratio (TRR) was 1.16 (95% CI: 1.05-1.28, P = 0.004). Training nurses did not affect HIV testing rates.

Overall, an average of 1.42% of HIV tests were positive (95% CI: 0.99-1.96%); however, the study was not powered to examine the effects of SHIP training on the likelihood of a positive test result.

SHIP addresses specific barriers that are unique to the general practice setting, and teaching strategies to overcome these and a rapid risk assessment that is appropriate for general practice.

This study demonstrates the impact of a tailored educational intervention on HIV testing rates in a deprived area of London. Such a sustained increase in HIV testing rates is rarely reported so this is one of the few studies that demonstrates the impact on general practice.

Much has been done to improve the awareness and early diagnosis of HIV including media campaigns for

HIV testing week, and NICE guidance which recommends HIV screening for two key at-risk groups, men who have sex with men and Black Africans. Despite this, issues such as stigma and barriers from both clinician and patient perspectives impede early diagnosis.

To improve diagnosis rates, much more work needs to be done to reduce perceived stigma, address confidentiality issues and empower those at risk to get tested, wherever it might be.

Dr Richard Ma

Pillay K, Gardner M, Gould A et al. Long term effect of primary health care training on HIV testing: A quasi-experimental evaluation of the Sexual Health in Practice (SHIP) intervention. PLoS ONE 13(8):e0199891